INTRAVENTRICULAR TUMORS

Lateral Ventricle Tumors: Subependymoma Central Neurocytoma Subependymal Giant Cell Tumor Choroid Plexus Neoplasms 3rd Ventricle Tumors: Subependymal Giant Cell Tumor Chordoid Glioma 4th Ventricle Tumors: Ependymomas Subependymoma Choroid Plexus Neoplasms Rosette-forming Glioneuronal Tumor

INTRA VENT RICUL AR TUMO RS Epen dymo ma Sube pend ymo ma

T1

T2

Ga

DWI

ADC

T2*

FLAIR

Locati on

(Ca+ / Hemorr hage)

Centr al Neuro cyto

4th ventri cle 4th ventri cle > latera l ventri cle Septu m pelluc idum

ma

or wall of latera l ventri cle 3rd ventri cle Fora men of Monr oe Atriu m of latera l ventri cle > 4th ventri cle Atriu m of latera l ventri cle > 3rd ventri cle > 4th ventri cle Anteri or 3rd ventri cle & hypot hala

Sube pend ymal Giant Cell Tumor (SGC T) Choro id Plexu s Neopl asms

Menin giom a

Chord oid Gliom a

mus (supr asella r) Roset teformi ng Glion euron al Tumor (RGN T)

(Periph ery)

(Ca+
+

/ Hemorr hage)

4th Ventri cle

+/- -

Ependymomas 5% intracranial neoplasms Perivascular Pseudorosettes World Health Organization (WHO) Grade II (low-grade, well-differentiated) Grade III (anaplastic) Cystic or Solid Often w/ small chunky calcification Intratumoral hemorrhage Mural Nodule "Plaster Cast-Like" extenstion filling: 4th ventricle Foramen of Luschka Foramen of Magendie Foramen magnum Subependymoma 0.5% intracranial neoplasms WHO grade I neoplasms w/ ependymal differentiation 4th ventricle (50%60%) Lateral ventricles (30%40%) M:F - 2:1 Benign/Rarely Excised No invasion or CSF dissemination (Unlike Ependymoma) No surrounding edema Well-circumscribed lesions

Attached to Ventricle Wall by narrow pedicle Cystic or Solid - Calcification Intratumoral hemorrhage Central Neurocytoma 0.5% intracranial neoplasms WHO grade Il neoplasms MC lateral ventricle (arise from septum pellucidum or ventricular wall) - extension into 3rd ventricle Neurocytic Rosettes Pineocytomatous Rosettes Circumscribed Lobular Mass Calcification (50%) Intratumoral hemorrhage Cystic "Bubbly" appearance due to the presence of multiple cysts Prominent flow voids Periventricular T2 Signal Intensity Subependymal Giant Cell Tumor (SGCT) WHO grade I lesion Pathognomonic for Tuberous Sclerosis Well-Circumscribed Solid Intraventricular Neoplasms Arise near Foramen of Monroe Slow growing - Calcification - Intratumoral hemorrhage Choroid Plexus Neoplasms Subdivided into 3 hstologic types: Choroid Plexus Papilloma (CPP) (WHO grade I) Atypical Choroid Plexus Papilloma (WHO grade II) Choroid Plexus Carcinoma (CPC) (WHO grade III) 3% Pediatric (20% of neoplasms in 1st year of life) 0.5% Adult Intracranial Neoplasms CPC occurs only within 2-3 yo Occurs w/n Choroid Plexus MC: Atrium of lateral ventricle (50%) 4th Ventrical (40%) Association c Aicardi & Li-Fraumeni syndromes All may demonstrate CSF dissemination (Image entire Neuroaxis) Vascular neoplasms c avid enhancement (flow voids are common)

NB: Long vascular pedicle which may twist & infarct tumor (No Enhancement Centrally) Enlarged Choroidal Artery (tumors w/n lateral ventricle atrium) - Calcification - Intratumoral hemorrhage Lobulated or Papillary appearance May have surroinds vasogenic edema Meningioma 2% intraventricular neoplasms WHO grade Il neoplasms MC w/n Atrium of lateral ventricle > 3rd ventricle > 4th ventricle F:M - 2:1 Psammoma bodies Calcification (50%) Chordoid Glioma WHO grade lI lesion MC anterior third ventricle & hypothalamus F:M - 3:1 Sx: Hypothalamic Dysfunction Homonymous Hemianopsia Intracranial Pressure Well-Circumscribed Vacuolization within the mucin-rich stroma resembles the mucin-rich matrix (Chordoma-like) Calcification - Cystic changes May have surroinds vasogenic edema Rosette-forming Glioneuronal Tumor (RGNT) WHO grade l lesion F:M - 2:1 MC 4th Ventricle Calcification Intratumoral hemorrhage Solid/Cystic Mass (resembles pilocytic astrocytoma) Small Neurocytic Rosettes